Support & Treatment for Preschoolers with ADHD

I'd recommend contacting the HALP clinic at UCSF. There may be a long-ish wait to get in, but their assessments are thorough and covered by many health insurance plans. They may advise medication as well, but first they will be able to give you a much deeper understanding of your son's neuro-cognitive profile. It's fascinating and I felt very confident in choosing medication after going over the results with the psychologists there. 

My son also very clearly had ADHD by age 4. No doubt in my mind or the Dr’s. He had every single symptom on the checklist (to the extreme). But I also hesitated to start medication because he just seemed so young. 

I finally gave in and started giving him Ritalin rx when he was 9 and I have to tell you the transformation in him was so amazing I have always regretted not having him start much sooner. 

He spent ages 4-9 being disliked by all of his teachers and potential friends because the ADHD made him so hard to be around. There was a huge cost to both his self-esteem and his academics. 

I understand your fear and concerns but if I had it to do over again I would absolutely have started medication at your child’s age. 

Hi there,

I totally understand your frustration as you always want to do the right thing by your kid. My 4 year old is pretty hyper as well and has sensory processing issues which results into not being able to focus on certain tasks for a long time and he is also constantly in motion!. But what I have seen is that as he is growing older things are changing for the better! We work on a daily basis with his class teacher to monitor any behavior triggers throughout the day and then come with strategies together. An example is moving heavy things gets him to a calmer state so his teacher lets him help out and move chairs before doing any project work. We also set expectations before every task both at home and school, example lunch time is coming up  "your body needs to be on the seat while eating"! small things like these have certainly helped, but its definitely a LOT of work.

My take is that before resigning to medication, work with the teacher to identify patterns and set strategies that you use consistently both at home and at school and then report out what you see work at home and vice versa. Good luck!!

Hi Mom! I know how you feel. We are battling the same issue, except our son is not 4.5, he's 12. We saw symptoms early elementary, but did nothing, dismissed it because we didn't want the label. Now, we find ourselves were we should have been 4 years ago, but at least we have the wisdom and informed decision if deciding to medicate, which we probably will very soon. There should be a few more "hoops" to the medication route,  not simply looking at your son and saying he has it and let's give him a prescription. There should be a psych eval at least.  I would like to discuss offline, I have more info I can share, but prefer not to type. I would recommend CHAD as a place for support and answers to your questions. There is also ADDitude magazine as well, plus many others. Good luck and God bless!

Dr. Schreier is one of the top psychiatrists in his field. If you weren't already seeing him, I would refer you. He has worked with our son's and will keep working with yours to find the right medication and balance. I understand your hesitation to use meds, but the flip side is not medicating and dealing with social consequences. In this Era they can be extreme. Also possible self esteem issues in adolescence.

The decision about how to best help a child with ADHD is certainly challenging.  Ultimately, it is an individual decision.  

When one of my kids was diagnosed, I had the same reaction as you.  I knew my child was challenging.  I talked with the pediatrician, who referred us to a specialist.  When the specialist diagnosed our child with ADHD, we initially did not want to believe it, either.  We certainly did not want to medicate our child.  Then we went to a class that Kaiser offered about ADHD medication, and it really changed our minds.  In the class, the doctors agreed that they would really love to find an alternative treatment that works and reviewed all the treatments that Kaiser has evaluated over the years (the Feingold diet, eliminate sugar, take Omega 3, Chinese herbs, etc), and the only treatment that has consistently worked so far is ADHD medication.  So, we started a drug trial for our son.  It took almost 2 months to find a medication and dose that worked without unpleasant side-effects.  Our son has been on medication for 3 ½ years, and I would never want to go back.  Medication allows my child to calm down and concentrate.  Life at home is usually peaceful now, and homework is not a torture anymore.   It is not a magic bullet, though.  My child still has trouble planning and organizing.  

Please don’t feel bad about wanting your child to thrive, nor feel bad if you do choose to medicate.  You clearly love and adore your child, and I’m sure you will always have his best interests at heart no matter how you decide to proceed.

Oooh! I will get flamed for this, so going anon, but he might be doing you a huge favor. We were in the same position, made to feel like criminals for our son's behavior. If we'd known it was ADHD earlier it would have helped him (and us) so much.

I've said it before, I'll say it again: spare yourself the $3,000.00 evaluation. Give him one Ritalin tablet. If he speeds up, he doesn't have ADHD. If he slows down, he does.

It'll be out of his system forever in four hours, so if you don't choose to medicate, no harm done. But at least you'll know. It is a brain chemistry issue -- not behavioral, and probably runs in one of your families. You will probably have to choose between medicating and his self esteem (difficulties in class, difficulties with friends). We chose the former, but he was 8 before we figured it out, and spent a ton of money in the process. I wish someone had told me about the one pill and an hour of observation. Good luck! Ours weaned off meds at 17 (their brains mature) and is doing well in college now!

You will likely get a lot of fired up responses here. I would be very cautious before medicating your preschool age kid. I have had issues with my youngest son - slightly different, but challenging in that he would not always focus. Turns out he is very smart and processes things slowly. Some of it could be boredom. High IQ kids don't always want to follow the standard. Schools try to create an environment that they expect kids to follow, but that's not always realistic for some kids. Also, I would look at his diet. If he is eating any processed food, this could have an adverse effect. Boys are active. Don't try to make him fit in a box. Some kids are more difficult than others. Patience. 

Hi,
As the parent of a toddler who I basically only medicate for high fevers, I totally understand the horror (and honestly, the allure - after the fourth nighttime awakening to blow a nose) in the idea of medicating a young child, especially on an ongoing basis. However, as a pediatric neuropsychologist, what I often talk to parents about are the "side effects" of not addressing ADHD. Chances are, your son is not unaware of all the feelings that accompany the complaints you ultimately hear. Your description of your son as an "outlier," and concrete examples such as knocking over the Christmas tree, as well as the feedback you've received from teachers and other parents suggest you are struggling with something unusual. I find parents almost always have a really good handle on their children, even if they don't always know how to make sense of all the pieces. What I look for is the point at which the child starts to exhibit a decline in self-esteem (in terms of social relationships, academics, even family relationships) related to the ADHD symptoms. I've seen smart kids calling themselves dumb, nice kids without friends, and high family conflict with the most loving and psychologically-minded parents. Those are the stories that break my heart. So, no, I don't think it's crazy to medicate if you feel concerned about your son's trajectory, and there is a ton to be said for early intervention. Medication often takes a bit of finnessing to get right, so I encourage families not to give up too soon, but it also leaves the system pretty quickly, so if you decide it was the wrong move, it is easily reversed. Ideally, medication is paired with a range of other interventions, and often allows kids to access environmental supports more readily. It's always worth talking to the school to see what strategies they are using and what resources they have available, and perhaps seeking an outside consult with someone who can suggest new ideas and support their implementation.

Your son is lucky to have you on his team, and you will be one of his biggest assets as he navigates the coming years. I've come to realize self-doubt is integral to the struggle to be a good parent, and there isn't always a "right way" to be found, despite how I might wish for it. So all we can do is listen to our instincts and do our best.

I heard of a school in Berkeley (private) which does tons of martial arts, as part of the school! It has worked great for my friend's son who was like you describe yours.

Our younger son was in a similar situation to yours at 5 years old in kindergarten.   After full evaluation by a well respected psychologist, and with the concurrence of our pediatrician, he started on stimulant medication.  He is now 24 years old, so I have some perspective on the journey.  Our son has been actively involved in decision making and med management from the outset.  Response to stimulant medication was immediate and obvious to all, including my son,—both when taking meds--and more tellingly on occasional days of missed pills.  In addition to being able to participate in school, it helped with his social interactions, and family relationships.

Medications are NOT a panacea.  Parenting skills, encouragement, therapy, school setting have all been important and different stages have presented different challenges.  Social interactions have been challenging, and episodes of being bullied have been difficult.  Currently I would say anxiety (somewhat hard-wired) and depression are bigger issues.  But he is living independently and working full time, albeit not at the job of his dreams...So I wish you and your family all the best in this complex situation--trust your judgment, and professionals that make sense, and don't reflexively refuse medication when it can be a tool which lets your child participate.  Also--as our pediatrician said to us back almost 20 years ago--it's a marathon, not a sprint...

Our son is almost 8 but preschool was when his adhd was really obvious, super challenging and especially difficult in school, group and unstructured settings. His adhd in preschool got him asked to leave a few preschools  because they “couldn’t handle him” and his big emotions. He never got invited to birthday parties or playdates and i never knew what to expect for his behavior so as a parent I walked on eggshells waiting for the next outburst. 

I later learned adhd and anxiety play a huge part in how he relates to the world, in addition to being a sensory sensitive kid. Life with my son Is still challenging but some maturity on his part has helped as well as our acceptance of him, the situation and our ability to make modifications to our lives so he/we are more successful has been key. We tried everything to avoid adhd medicine for him from elimination diets to behavior modification tactics, OT, and holistic methods but in the end medicine has made all the difference and I wish we would have considered medication sooner. The key is finding a good psychiatrist/doctor whom you work with closely to determine the right med and monitor closely. We did not have a good experience with stimulant meds but at your sons age that might be your only option. Other key pieces of advice, get some good sitters so you can have your bucket full to take care of him. Have this sitter help run some play dates and make everything short sweet and successful. get a therapist who can help you through the grieving process of having a “different” kid. Our son is so smart and creative and he wouldn’t be him without adhd but there is a sense of loss that your child’s life and your family doesn’t operate the same as other families. Get your parenting under control so your son has clear limits and expectations. Kids who are on the go generally deal in black and white which is why video games are so alluring. Plus they want new and novel experiences. Structure is key. Scheduling the day with pictures and a chart will help your child who’s likely disorganized to start learning those skills. Above all else watch your kids self esteem because your kid knows or will know he’s different. If he gets in trouble a lot at school you may want to evaluate his placement. He needs lots of positivity and redos and he does not need the label of bad kid - but adhd kids get that label fast and furious. Watch your connection with him. Keep it strong and safe and loving. Make sure you have special time together every day.  Karate and tae kwon do at the right place is super helpful.